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Hyperkalemia

Definition:

  • Serum K+ >5.3-5.5

 

Etiology:

  • Pseudohyperkalemia- K release from cells after blood draw, IVF with K
  • Hemolysis
  • Marked thrombocytosis or leukocytosis
  • Excessive K intake
  • Ingestion (K Supplements, dietary salt substitutes)
  • Iatrogenic
  • Impaired excretion
  • Low GFR (AKI or CKD)
  • Low mineralocorticoid state (adrenal insufficiency, type IV RTA)
  • Drugs (spironolactone, ACEi, ARB, TMP-SMX, NSAIDs, digitalis overdose, heparin, chemo therapeutic agents)
  • Shift from intracellular to extracellular compartment
  • Acidosis
  • Insulin deficiency or resistance including DKA
  • Cell death (rhabdomyolysis, burns, tumor lysis)
  • Retroperitoneal hemorrhage
  • Old (hymolyzed) pRBC transfusion

 

Clinical manifestations:

  • Weakness, nausea, paresthesias, palpitations

Evaluation:

  • Repeat serum K+ and assess renal function studies including serum Cr and BUN
  • Order stat ECG to evaluate for hyperkalemia related changes (Tall peaked “tented” T waves, PR interval prolongation followed by loss of P waves, QRS widening, sinus wave pattern, VF/asysteole/PEA
  • Review medications for offending drugs and stop as appropriate/indicated

 

Management:

 

 

 

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